Ulster Med J 2014;83(3):133-134
Editorial The Last Post There is a temptation for your editor, at the end of his term, if not his rope, to get a few well-chosen things off his chest. I was reminded of Senator George Mitchell’s concluding remark at the completion of the Good Friday Agreement in 1997, “I’m so sorry to leave but I can’t wait to go.” Yes, that resonates. Being editor can be a lonely berth at times channeling Coleridge’s ancient mariner, and feeling ‘alone on a wide wide sea.’ However ‘No man is an island’, John Donne reminds us. True, except of course for Kenny Rogers and Dolly Parton, who were two islands. In a stream, to be precise. We are an island race. By definition therefore, our shore defines us, literally. This Province (and our Society’s symbol) is The Red Hand. There are many legends relating to this symbol’s origin. Here are two. The Galician King of Spain, Milesius, in 500BC sent his three sons, Ir, Heber and Heremon, to claim Ireland, promising the island to the first son to touch its soil. Each of the parties raced towards the shore and one of the sons cut off his own hand with a sword and throwing it laid claim to the country. In another version, the captain of a Viking longboat, approaching Ireland promised that the first man to put his hand on the land could claim it. A mercenary on board named O’Neill used his sword to severe his own hand, and the mutilated appendage thrown ashore claimed it for him and his family, becoming the symbol for Ulster -the Red Hand. Ulster generally and Belfast specifically is forever defined by one ship. A vessel so well known that it’s name itself has become a metaphor: the Titanic. The Titanic sank at 2.20am on April 15th, 1912, about 400 miles from Newfoundland, struck by an iceberg on its starboard side. Titanic’s name is synonymous with the power of nature, and the impotence and arrogance of man. The other ship that stands as metaphor, is, I would contend, the Marie Celeste. Possibly one of the most famous ships of all time the Marie Celeste is testament to the unsolved mystery and the ghost ship. Surprisingly its discovery, abandoned and tacking erratically, occurred as recently as December 1872. The ship, originally registered as the Amazon in Nova Scotia, had been reregistered as the Marie Celeste in New York. Probably the most likely theory is that barrels of alcohol held in inferior porous red oak casks emitted fumes, and an explosion ensued, frightening the crew. The captain ordered the lifeboat deployed (a tow line was found) but the life boat being cut adrift, meant death for its occupants, leaving the Marie Celeste intact, and sailing into mythology as an enigma. I thought it might be interesting, for me at least, to map out my five year term in terms of world events. When I began the editorial cycle, there was lamentable pain in the Middle East,
© The Ulster Medical Society, 2014.
and also in another island, remote Iceland, that volcano with, for many of us, the unpronounceable name ‘Eyjafjallajökull’ (Ah-uh-fyat-luh-yoe-kuutl-uh’) was spewing ash carried south by prevailing winds and paralysing the aviation industry. As I write this, a second Icelandic volcano -Bárðarbunga -lying under a thick glacier is excreting lava. Between these two events, Iceland went about its quiet industrious way, recovering from an economic crisis, and if the proposed energy interconnector with the United Kingdom is built, the citizens of Iceland are set to become rich enough to give the Sultan of Brunei run for his money. Sadly, the Middle East remains a different story. The constant in the chaos was the heartbreaking loss of so many innocent lives. As Wilfred Owen said, “My subject is war, and the pity of war. The poetry is in the pity.” The big news stories for 2010 were the BP oil spill from the Deepwater Horizon drilling platform in the Gulf of Mexico. Other events that year included the rise of The Tea Party, Obamacare, and in April, the launch of the iPad. Can you imagine life before the iPad? In 2011, on May 1, Osama Bin Ladin was killed. In Norway the Utøya massacre occurred killing 69 students from the Workers’ Youth League; Adele released “21”, and the Arab Spring began. In 2012 North Korea, his uber-nourished third son Kim Jon Un replaced the deceased Dear Leader Kim Jong Il and Oscar Pistorius became the first double amputee to compete in the Olympics. His après Olympic career however presumably wasn’t what he had planned. In 2013 Pope Benedict resigned, the first Pontiff so to do in 600 years. His successor, an Argentinian Jesuit, took the name Francis, a first for papal nomenclature. Also in that year, Edward Snowden’s whistleblowing revelations would reveal the extent of the USA’s espionage activities. Five years clocked up and I wondered what had been achieved? Building on the excellent advances of my predecessor, I wanted to emphasize medical education in its broadest sense. Firstly, I introduced Review Papers. Their primary purpose was to inform the readership about recent advances that had occurred in other people’s specialties. An acknowledged expert would write each. There is no doubt in my view that an evangelical enthusiast is hard to beat. Again, paraphrasing Coleridge: And when at last that face I see I see the man that must hear me To him my tale I teach.1 Next came the Grand Rounds. These articles were to assist those preparing for undergraduate and postgraduate
www.ums.ac.uk
134
The Ulster Medical Journal
examinations and would be more practical than theoretical. The Pictorial Reviews and Game Changers are also extensions of that. The Bookcase section was my attempt to introduce a more holistic non-medical strand, and perhaps stimulate the occasional reader, if only with outrage. Social networking was the next step with a presence on Twitter and Facebook. QR codes followed these, but for us, are in their infancy. I was also particularly pleased to have introduced bilateral anonymity for reviewers and submitters and CME credits for reviewers. The anonymity has worked well, protecting both those submitting papers and reviewers alike. Wherever possible, I have invited reviewers from outside Northern Ireland, and indeed from outside the United Kingdom. I feel this adds to the Journal’s perspective. The vast majority of reviewers provide very positive critiques, and this leaves a paper much stronger in the end. Being a reviewer is a hard station, so I was delighted to reward their endeavors with CME credits hosted by the Ulster Medical Society. Case reports Continuing my aquatic metaphor, identifying promise in a case report can be like looking for water in the desert. In that sense, the editor and reviewer resorts to dowsing, or divining: Unfussed. The pluck came sharp as a string. The rod jerked with precise convulsions, Spring Water suddenly broadcasting Through a green hazel its secret stations.2 Over the last five years I have used an alternative strategy: converting case reports into letters to the editor and with some success. The case report is of course the first tentative step for junior doctors (myself included) but there is a fundamental problem with it. It rarely has anything useful to add to medical literature’s canon. I am very empathetic to the needs of trainee doctors in this respect. They have a requirement to be seen to pursue intellectual enquiry (let’s call it ‘research’) as a means to professional advancement. Fair enough. The problem is that many of the case reports received are in fact straightforward expositions of uncommon conditions. A further complication ensues. In your editor’s opinion, the worth suggested by the first author, very often is at variance with the experience of the more battle-scarred practitioner, and probably reflects the youthful blank canvas of that first author. The postgraduate medical curriculum is now very full, planted thick with validated, targeted medical examinations to test the worthiness of the practitioner. Understandably therefore there is little room for research. I would suggest that it might be much more practical and targeted to employ a system of learning such as a Practice-Based Learning module, where
© The Ulster Medical Society, 2014.
critical appraisal of work can be done using accepted metrics and international norms. As the cited reason for case reports and papers is usually given as “the ability to critically appraise a paper”, it would seem more appropriate to use this rather than embark on a relatively redundant case report. Anyway, I digress. By converting these case reports into letters to the editor, the trainee gets the work published, and cited, but for those interested in this kind of thing, it does not form part of the Journal’s impact factor. This I would suggest is a win win. It has been a privilege to have been at the helm, these five years. My final nod to Coleridge: He rose as one that has been stunned And is of sense forlorn A sadder but a wiser man He rose the morrow morn.1 Well, not sadder, but wiser. One leaves with the sense of what is achievable. One recognises a colleague who might help, and one that certainly won’t. Most importantly, one has the wisdom to know the difference. I would especially like to thank Mary Crickard, Marie Murphy and the Journal’s editorial board. They made the Journal better than when they found it and they did the same with me. I always thought there was an additional frisson to be had with me, notionally in charge, wondering in what month the September edition would actually be published. We always made it, but just. With my worthy successor, John Purvis, a cardiologist from Altnagelvin in Legend -Derry, deadlines will not be a problem. This will be a relief, not least for Peter Mahaffey, the long-suffering studio editor in Dorman’s. Peter deserves great praise because despite my chaotic, entropic and scattergun approach, he always remained calm, and always delivered. My very best wishes to John. He has worked tirelessly and methodically in preparation for becoming editor. There is I believe a Royal Navy exchange when the officer of the watch is relieved. The retiring officer says, “I give you the ship” and his replacement says, “I have the ship.” He has indeed. Please do keep sending him your good papers. Adieu Barry Kelly Honorary Editor REFERENCES 1.
Heaney, S. The Diviner. Opened Ground, Poems 1966 -1996. London. Faber and Faber. 1998.
2.
Coleridge, S. The Rime of the Ancient Mariner. The Nation’s Favourite Poems. London. BBC Books. 1996.
www.ums.ac.uk
Editorial The Last Post There is a temptation for your editor, at the end of his term, if not his rope, to get a few well-chosen things off his chest. I was reminded of Senator George Mitchell’s concluding remark at the completion of the Good Friday Agreement in 1997, “I’m so sorry to leave but I can’t wait to go.” Yes, that resonates. Being editor can be a lonely berth at times channeling Coleridge’s ancient mariner, and feeling ‘alone on a wide wide sea.’ However ‘No man is an island’, John Donne reminds us. True, except of course for Kenny Rogers and Dolly Parton, who were two islands. In a stream, to be precise. We are an island race. By definition therefore, our shore defines us, literally. This Province (and our Society’s symbol) is The Red Hand. There are many legends relating to this symbol’s origin. Here are two. The Galician King of Spain, Milesius, in 500BC sent his three sons, Ir, Heber and Heremon, to claim Ireland, promising the island to the first son to touch its soil. Each of the parties raced towards the shore and one of the sons cut off his own hand with a sword and throwing it laid claim to the country. In another version, the captain of a Viking longboat, approaching Ireland promised that the first man to put his hand on the land could claim it. A mercenary on board named O’Neill used his sword to severe his own hand, and the mutilated appendage thrown ashore claimed it for him and his family, becoming the symbol for Ulster -the Red Hand. Ulster generally and Belfast specifically is forever defined by one ship. A vessel so well known that it’s name itself has become a metaphor: the Titanic. The Titanic sank at 2.20am on April 15th, 1912, about 400 miles from Newfoundland, struck by an iceberg on its starboard side. Titanic’s name is synonymous with the power of nature, and the impotence and arrogance of man. The other ship that stands as metaphor, is, I would contend, the Marie Celeste. Possibly one of the most famous ships of all time the Marie Celeste is testament to the unsolved mystery and the ghost ship. Surprisingly its discovery, abandoned and tacking erratically, occurred as recently as December 1872. The ship, originally registered as the Amazon in Nova Scotia, had been reregistered as the Marie Celeste in New York. Probably the most likely theory is that barrels of alcohol held in inferior porous red oak casks emitted fumes, and an explosion ensued, frightening the crew. The captain ordered the lifeboat deployed (a tow line was found) but the life boat being cut adrift, meant death for its occupants, leaving the Marie Celeste intact, and sailing into mythology as an enigma. I thought it might be interesting, for me at least, to map out my five year term in terms of world events. When I began the editorial cycle, there was lamentable pain in the Middle East,
© The Ulster Medical Society, 2014.
and also in another island, remote Iceland, that volcano with, for many of us, the unpronounceable name ‘Eyjafjallajökull’ (Ah-uh-fyat-luh-yoe-kuutl-uh’) was spewing ash carried south by prevailing winds and paralysing the aviation industry. As I write this, a second Icelandic volcano -Bárðarbunga -lying under a thick glacier is excreting lava. Between these two events, Iceland went about its quiet industrious way, recovering from an economic crisis, and if the proposed energy interconnector with the United Kingdom is built, the citizens of Iceland are set to become rich enough to give the Sultan of Brunei run for his money. Sadly, the Middle East remains a different story. The constant in the chaos was the heartbreaking loss of so many innocent lives. As Wilfred Owen said, “My subject is war, and the pity of war. The poetry is in the pity.” The big news stories for 2010 were the BP oil spill from the Deepwater Horizon drilling platform in the Gulf of Mexico. Other events that year included the rise of The Tea Party, Obamacare, and in April, the launch of the iPad. Can you imagine life before the iPad? In 2011, on May 1, Osama Bin Ladin was killed. In Norway the Utøya massacre occurred killing 69 students from the Workers’ Youth League; Adele released “21”, and the Arab Spring began. In 2012 North Korea, his uber-nourished third son Kim Jon Un replaced the deceased Dear Leader Kim Jong Il and Oscar Pistorius became the first double amputee to compete in the Olympics. His après Olympic career however presumably wasn’t what he had planned. In 2013 Pope Benedict resigned, the first Pontiff so to do in 600 years. His successor, an Argentinian Jesuit, took the name Francis, a first for papal nomenclature. Also in that year, Edward Snowden’s whistleblowing revelations would reveal the extent of the USA’s espionage activities. Five years clocked up and I wondered what had been achieved? Building on the excellent advances of my predecessor, I wanted to emphasize medical education in its broadest sense. Firstly, I introduced Review Papers. Their primary purpose was to inform the readership about recent advances that had occurred in other people’s specialties. An acknowledged expert would write each. There is no doubt in my view that an evangelical enthusiast is hard to beat. Again, paraphrasing Coleridge: And when at last that face I see I see the man that must hear me To him my tale I teach.1 Next came the Grand Rounds. These articles were to assist those preparing for undergraduate and postgraduate
www.ums.ac.uk
134
The Ulster Medical Journal
examinations and would be more practical than theoretical. The Pictorial Reviews and Game Changers are also extensions of that. The Bookcase section was my attempt to introduce a more holistic non-medical strand, and perhaps stimulate the occasional reader, if only with outrage. Social networking was the next step with a presence on Twitter and Facebook. QR codes followed these, but for us, are in their infancy. I was also particularly pleased to have introduced bilateral anonymity for reviewers and submitters and CME credits for reviewers. The anonymity has worked well, protecting both those submitting papers and reviewers alike. Wherever possible, I have invited reviewers from outside Northern Ireland, and indeed from outside the United Kingdom. I feel this adds to the Journal’s perspective. The vast majority of reviewers provide very positive critiques, and this leaves a paper much stronger in the end. Being a reviewer is a hard station, so I was delighted to reward their endeavors with CME credits hosted by the Ulster Medical Society. Case reports Continuing my aquatic metaphor, identifying promise in a case report can be like looking for water in the desert. In that sense, the editor and reviewer resorts to dowsing, or divining: Unfussed. The pluck came sharp as a string. The rod jerked with precise convulsions, Spring Water suddenly broadcasting Through a green hazel its secret stations.2 Over the last five years I have used an alternative strategy: converting case reports into letters to the editor and with some success. The case report is of course the first tentative step for junior doctors (myself included) but there is a fundamental problem with it. It rarely has anything useful to add to medical literature’s canon. I am very empathetic to the needs of trainee doctors in this respect. They have a requirement to be seen to pursue intellectual enquiry (let’s call it ‘research’) as a means to professional advancement. Fair enough. The problem is that many of the case reports received are in fact straightforward expositions of uncommon conditions. A further complication ensues. In your editor’s opinion, the worth suggested by the first author, very often is at variance with the experience of the more battle-scarred practitioner, and probably reflects the youthful blank canvas of that first author. The postgraduate medical curriculum is now very full, planted thick with validated, targeted medical examinations to test the worthiness of the practitioner. Understandably therefore there is little room for research. I would suggest that it might be much more practical and targeted to employ a system of learning such as a Practice-Based Learning module, where
© The Ulster Medical Society, 2014.
critical appraisal of work can be done using accepted metrics and international norms. As the cited reason for case reports and papers is usually given as “the ability to critically appraise a paper”, it would seem more appropriate to use this rather than embark on a relatively redundant case report. Anyway, I digress. By converting these case reports into letters to the editor, the trainee gets the work published, and cited, but for those interested in this kind of thing, it does not form part of the Journal’s impact factor. This I would suggest is a win win. It has been a privilege to have been at the helm, these five years. My final nod to Coleridge: He rose as one that has been stunned And is of sense forlorn A sadder but a wiser man He rose the morrow morn.1 Well, not sadder, but wiser. One leaves with the sense of what is achievable. One recognises a colleague who might help, and one that certainly won’t. Most importantly, one has the wisdom to know the difference. I would especially like to thank Mary Crickard, Marie Murphy and the Journal’s editorial board. They made the Journal better than when they found it and they did the same with me. I always thought there was an additional frisson to be had with me, notionally in charge, wondering in what month the September edition would actually be published. We always made it, but just. With my worthy successor, John Purvis, a cardiologist from Altnagelvin in Legend -Derry, deadlines will not be a problem. This will be a relief, not least for Peter Mahaffey, the long-suffering studio editor in Dorman’s. Peter deserves great praise because despite my chaotic, entropic and scattergun approach, he always remained calm, and always delivered. My very best wishes to John. He has worked tirelessly and methodically in preparation for becoming editor. There is I believe a Royal Navy exchange when the officer of the watch is relieved. The retiring officer says, “I give you the ship” and his replacement says, “I have the ship.” He has indeed. Please do keep sending him your good papers. Adieu Barry Kelly Honorary Editor REFERENCES 1.
Heaney, S. The Diviner. Opened Ground, Poems 1966 -1996. London. Faber and Faber. 1998.
2.
Coleridge, S. The Rime of the Ancient Mariner. The Nation’s Favourite Poems. London. BBC Books. 1996.
www.ums.ac.uk
